Early outcomes after intra-cardiac repair for late-presenting tetralogy of Fallot
Keywords:
tetralogy of Fallot, late presentation, transannular patch, right ventricular dysfunctionAbstract
Background: Intra-cardiac repair is the primary treatment for tetralogy of Fallot (TOF) and is ideally performed during infancy for optimal outcomes. However, most of the patients present later in life in Bangladesh. This study aimed to assess the early outcomes of intra-cardiac repair among late-presenting TOF patients.
Methods: This study reviewed the hospital records of selected 60 consecutive patients with TOF who underwent intra-cardiac repair at the Department of Cardiac Surgery, Bangladesh Medical University, between January and December 2025. Patients suffering from TOF with discontinuous pulmonary arteries, pulmonary atresia, atrio-ventricular septal defects, absent pulmonary valve syndrome, with a McGoon’s ratio less than 1.3 and palliative operations (i.e., Blalock-Taussig-Thomas shunt) were excluded. Preoperative clinical information and relevant investigations were recorded. The early outcomes were analysed from clinical follow up, in-hospital mortality, postoperative management, any major morbidities and echocardiogram reports at 90 days post-surgery.
Results: Thirty-five (58.3%) patients were male and the median age was 6 years (inter-quartile range: 5–10 years). Their clinical evaluation revealed, associated major aorto-pulmonary collateral arteries in 12 (20%) patients. During surgical intervention, trans-annular patch augmentation was performed in 18 (30%) patients with severe right ventricular outflow tract obstruction. Moderate to severe pulmonary regurgitation occurred in all the patients treated with trans-annular patch. Severe right ventricular dysfunction due to free pulmonary regurgitation was observed in 5 (8.3%) patients. In-hospital mortality was observed in 5 (8.3%). Follow-up evaluation on 52 patients showed severe right ventricular dysfunction in 7 (13.5%) patients.
Conclusion: This study suggests that late surgical correction can provide acceptable early outcomes such as preservation of pulmonary valve function and right ventricular stability. Mid- and long-term outcomes should be evaluated in future studies.
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